"A healthy mouth, makes a pleasant and functional
social message positive and reassuring."

dc. Maurizio Serafini

Clinical Cases

Oral Implantology

COMPLETE REHABILITATION OF TWO ARCHES WITH TECHNICAL ONE TO ONE

PRESENTATION OF CASE REPORT

A male patient aged 56, no smoker. comes our attention for the loss of three teeth in the lower jaw 3.1 - 3.7 - 4.1.

This condition gives him, no small frustration, given that works in contact with the public.

At the examination, ( Photos. 1 - 2 3 )

Lower jaw Photo. 3

we soon realized that we were faced with a serious clinical situation of chronic periodontal patology.

This situation, causes the weakening of the tissues that are at support of the teeth, soft tissue hyperemic unstuck from the teeth, periodontal pocket formation, tooth hyper mobility, profuse bleeding spontaneous and at the them brushing, so much so that the patient afraid to brush your teeth, in fact, as can be seen oral hygiene is poor and the same states, often find the pillow stained with blood.

As in more severe cases, where it manifests even with the loss of one or more dental elements, the same situation we find in the patient concerned.
Also you can see the old rehabilitation with fixed prosthesis, incongruous.

TREATMENT

After informing the patient and made iconographic view what type of treatment meant to offer, we obtained informed consent to proceed.

After a survey of first-level ( OPT x-ray), for overview, which provides us with a first reading of the periodontal damage, confirmation as explained above, as well as the huge crater that remains, for about two months, below right and a sketch of the impacted tooth.

Photo 4

In a first step, we did perform: Antibiotic prophylaxis: Ac. Clavulanate and amoxicillin, 1g. every 12 hours and antiseptic mouthwash with chlorhexidine 0.2% for three times a day for 30 second and oral hygiene with ultrasound scaling, it was repeated at a distance of fifteen days, after this period, we have had a remission of acute inflammation of the soft tissue as shown in Photo. 5.

We then moved on to an examination of the second level: Dental - Scan reconstructed in 3D with special software "3D implant," where you can see in more detail the serious loss of bone around the teeth, the craters (periodontal pockets) around they, the compromise furcation root at level of the posterior teeth, the tooth including the front lower, the residual bone volume. Photos. 6-7-8-9-10-11-12

UPPER MAXILLARY

LOWER MAXILLARY


IMPLANT PLANNING

With Implant 3D software, we plan the surgery and I decided to put a number of implants equal to the number of teeth that should be in the wild, One to One technique, and we have reported on the OPT the lengths, diameters, degree of insertion of the implants, the bone volume, for to have everything under control during surgery. Photos: 13 - 14 15.

The choice for this type surgery, is due to the fact which Id like to restore a normal occlusion with an implant post - extractive and not, perfectly balanced; that can better dissipate the load forces over a large area of cortical and cancellous bone.

Choosing the implant of choice by the upper incisors to premolars, falls on the new generation of tapered implants.

In fact, the morphology of the collar "Concave Conical Reverse Neck" reduces stress in the cortical region, minimizes Crestal Bone Remodeling and ensures the maintenance of the Crestal bone in the long term.

This allows us to have an increase in bone volume between an implant and the contiguous, called: Biological Surface Area, thus obtaining a better vascularization of the stroma papillary, with formation of a true papilla.

The choice of packaging single crowns, has a threefold purpose:

The first is certainly the most important for the health of the implants is the "oral hygiene"
The second is to have an aesthetic similar to that of natural teeth.
The third is that, if there is failure of an implant, because it no longer fulfills the conditions mentioned above, it doesnt compromise the entire job.

Before surgery, the patient has performed examinations and routine hematological
cardiac examination, electrocardiogram, echocardiogram and ecocolordoppler TSA.


THE SURGERY

It is planned, for convenience of the patient, in four steps, one after one month of the other, starting from the upper arch, but for convenience descriptive and as usually treat these cases, we will describe it in two steps.

The patient is prescribed antibiotics amoxicillin + ac. Clavulanic acid 2 g / day from the day before surgery and for the next 5 days, from the day of surgery anti-inflammatory Seaprose cpr.30mg for 4 day and daily disinfection with chlorhexidine 0,20% for the removal of sutures.

UPPER ARCH

Subject to draw 28 ml venous blood to obtain, after centrifugation, the PRP. Photos 16-17

We proceeded with the avulsion of teeth, before the left side and then the right side, Photos 18 - 19-20 - 21 - 22 - 23-24.

Have been inserted n 14 implants of which 10 tapered to immediate loading with sizes ranging from length between 15mm. to 13mm. with diameters ranging from 5mm. to 3.75mm. and n 4 spirals, two at right with length 10mm. and diameter 6mm. and two at left: length of 10mm. diameter and 5 mm., at rest, because we made the lifting crestal sinus.

After the surgery, were included 2 provisional prosthesis in composite, reinforced with metal.

LOWER ARCH

The second surgery, we proceed with the same medication above indicates, one month after the first. Subject to draw 28 ml of venous blood, to obtain the growth factors. Photos 25 -26

We proceed with the avulsion of teeth left side, chirurgical toillette post-extraction and insertion of implants immediately loaded. Photos 27 -28

We proceed with the right side, where we have a distal edentulous area and an sketch of impacted tooth, between 4.2 and 4.3; the photos 29 -30-31-32 show enucleation of element included together the extraction of distal teeth, the insertion of implants post extraction and homologous bone grafting, recovered from the milling of dental cavities, with P.R.P.

Have been inserted n. 12 plants, of which 7 tapered immediate loading, with sizes ranging from length between 16mm. to 10mm., with diameters ranging from 4.2mm. to 5mm. and n 4 spirals, two at right with length between 13 mm. to 8mm. diameter 5mm. and 2 implants at left, whit lengths between 11.5mm at 10mm. and 6mm.of diameter, one monolithic of 15mm length. and 3.3mm. width.

Checking after seven months for to load the implants facilities of the upper left fallow.

The X-ray highlights the growth of bone into the maxillary sinuses and around the implants.
Photo 33.

After two months, return to detect the fingerprints of the upper arch. Photo. 34.

We treat implants the same way as natural teeth, that is prepare the abutments in the mouth, with specific drills for titanium and copious irrigation, bypassing the transfert technique.

In these two slides, we can observe the health of the mucous with papillae formed. Photos 35 -36.

It will follow the diagnostic wax-up, the try-in of the same, to correct imperfections, in fact we were able to bridge the huge initial diastema.

The package of zirconia ceramic, single crowns one to one, except a bridge, four elements since, always in zirconia - ceramic. (2.5-2.6-2.7-2.8) Photos. 37 -38 -39 -40.

After one month we took the fingerprints of the lower arch and here we observed the same process of the upper, with diagnostic wax and zirconia - ceramics.Photos.42-43-44-45-46.

WORK COMPLETED:
PHOTOS: 47-48-49-50